Will the ACA survive SCOTUS?

It's anyone's guess as to whether the Affordable Care Act will survive it's latest challenge. This week, the Supreme Court heard arguments in the case of King v. Burwell.

That case centered on whether or not the law meant to provide tax subsidies to eligible people in all states, or only in states that set up their own exchange. As Solicitor General Don Verrilli argued, there are several reasons why subsidies must be available through the federal exchange as well.

For starters, it makes no sense that Congress would have purposely written a death spiral provision into the law. If tax subsidies were not available to people in some states, it's unlikely that healthy people would sign up for insurance. In those states, only sick people would sign up, and insurance companies would have to hike up premiums to cover the cost of medical care.

In order to prevent such a death spiral, states would have to set up their own exchanges, and that would create what Justice Anthony Kennedy called a “serious constitutional problem.”

By interpreting the ACA to only provide subsidies in state-run exchanges, the law would essentially require that states set up their own exchange. That requirement would be a pretty clear violation of the 10th Amendment, and so that interpretation doesn't make a whole lot of sense.

But, the Right-wing Justices have never limited themselves to what's sensible, and there is still a chance that they may influence more-moderate members of our nation's highest court.

If the Supreme Court sides with the plaintiffs, 13 million Americans in 34 states will be left scrambling to save their coverage. While some may be able to figure out how to pay premiums without the subsidies, the vast majority of people will lose the insurance coverage that they finally got.

It's not an exaggeration to say that thousands of Americans could die if our Supreme Court strikes down federal subsidies.

We probably won't know their ruling until June, so we've got to keep the pressure on Congress and force them to fix the law so that Americans can keep their much-needed healthcare.


RichardofJeffersonCity's picture
RichardofJeffer... 9 years 15 weeks ago

I'm not a support of the ACA to begin with, but in a way I would like to the Supreme Court rule against the ACA. I think the backlash could lead to reforms limiting the powers of the Supreme Court. The ACA exist as weak public protection that could've been a massively effective healthcare tool for the public; instead, it is a massive public subsidy to insurance company with a mandate forcing people to buy insurance from a private company, but not allowing the citizens a public option. We could trash it, for what it's worth, if it leads to a public revolt against the 9 person (SCOTUS) democracy that the US has developed into.

rocketman1701's picture
rocketman1701 9 years 15 weeks ago

Blast durn it all to heck... you have a point. However, the repubs are masters at lying and would be all over it as a blow for freedom, how it will save millions of lives, be the best thing ever and now we should do away with medicare, food stamps, and any social programs. It would be touted by Faux News as the fall of Obama and his reign of terror....

I don't believe any of the above responses are true. I am saying the repubs will scream long and loud and hard that they are.

As crappy as it is, as much as we need a public option, if SCOTUS guts it, it will not rise like the Phoenix, but rot like a dead fish, and take many of those without a voice with it.

rlthrockmorton 9 years 15 weeks ago

So, lets say that the Supreme Court rules against Obamacare subsidies for states that did not open their own exchanges. Then, the subsidy would be gone but the requirement to obtain healthcare insurance would remain. That means that the rednecks (states whose exchanges are run by the Federal Government) would be cut out of the subsidy, but they would still have to either buy healthcare insurance or pay the tax penalty for not having such insurance.

Makes me almost wish that the SCOTUS rules against Obamacare!

j.jonik 9 years 15 weeks ago

It hasn't been explained much (if at all) why right wingers would attack the ACA...a clone of RomneyCare and the child of the Heritage Foundation.

It sure seems that they'd rather not have a black person, and a Dimocrat to boot, get credit for what is essentially a HUGE gift to Wall Street via private insurers' Billions of dollars of investments in the worst health-damaging industries, for starters.
If the Repugs kill the ACA and dump untold thousands off the system, how will those Insurers feel about that? Where are their full page NYTimes ads condemning the anti ACA factions? Don't those insurers LOVE the idea that millions of people are being compelled, under threat of IRS penalties, to patronize their private businesses?...not to mention providing tax revenues that go to insurers for low-income coverage.

It's easy to smell a fix...a contrived distraction. All this anti "Obamacare" stuff may be simply aimed at a racist Repug constituency, and the insurers understand this...so they don't raise a finger to fight the anti ACA movement. No need to. The ACA is probably a shoe-in. Compulsory capitalism for all.

This current battle benefits insurers. It nicely distracts from thoughts of Single Payer, and that little detail about big insurer investments in health-damaging, environmentally-destructive, war-supplying, anti-union, child-labor-using, etc etc etc industries

ChristopehrCurrie's picture
ChristopehrCurrie 9 years 15 weeks ago

If the five Republican "Justices" of the US Supreme Court decied to trash "Obamacare", they will end up KILLING (literally) FAR MORE AMERICANS PER YEAR than El Qeada, the Talaban, ISIS, and Boko Haram combined! That will technically make those five "Justices" the world's leading American-killing-global-wide terrorist organization! Of course, every member of Congress who voted against "Obamacare" will then be viewed from a similar point of view. The end result might be to establish a single-payer "Medicare for All" program (after most of those Republican corporate avatars get voted out of Congress in the 2016 elections).

Aliceinwonderland's picture
Aliceinwonderland 9 years 15 weeks ago

I've had similar thoughts, Christopher. The outcome of the ACA getting dumped could ultimately result in something better... or it could land us right back where we started: health coverage for healthy people only; sick people kicked to the curb to die. How uniquely American is that?

bobcox's picture
bobcox 9 years 15 weeks ago

I think this is a round-the-barn attempt to kill the ACA. The real thing the insurance and medical and hospital peopl want is to do is to kill the entire bill. But the part of ACA which controls thrir future cost/premium structure was written too well and more difficult to attack directly so they are attacking some of the weaker portions of the bill. The doctors, pharmaceuticals, hospitals and insurance companies like the 15-18 per cent medical care inflation rate so they want to eliminate the ACA so they can make more billions in profitsd. They don't care if they bankrupt their patients or the contry as long as they can make more money.

Kend's picture
Kend 9 years 15 weeks ago

I think you are all reading the right wrong. They or I just don't like anything run by the Big Federal monster. To get the single payer system you want you need to do it at the state level. That's how we did it in Canada. Start with one and when all the other states see how good it is they will follow. At a national level you have nothing to compare how well it is run. The whole ACA seems to have been pushed on everyone with very little public debate. It turned the whole US health care system upside down just to insure 7.5 million people. There must have been a better way to insure them.

Kend's picture
Kend 9 years 15 weeks ago

Sorry but I have to say I told you so. A train derailed in Virgina yesterday hauling oil. I warned you all this was going to happen. Hauling oil by rail is scary. It is just a matter of time when it happens when they are going through a town or city. And yes the railway was owned by Warren Buffet. Just as I said Obama delays Keystone so his big donor can make billions hauling oil by rail instead of moving it safely under the ground in a pipeline..

Aliceinwonderland's picture
Aliceinwonderland 9 years 15 weeks ago

Reply to #8: The hell with you, Kend. Spare us the "Sorry" crap. In your country nobody gets bankrupted by medical bills or dies of a treatable illness. You've no skin in the game. And don't tell me you've something at stake here because you purchased a second home in Arizona or wherever the hell it is. We don't need to hear that bloody crap from a goddam Canadian.

Reply to #9: Far as the Keystone XL Pipeline is concerned, well boo-hoo-hoo. Go cry in your beer. And while you're at it you can spare us the usual BS about how "safe" pipelines are compared to trains. Pipelines leak, and they explode. It happens. And if you don't believe me, click on the links below. I dare you!



Then comes your reward, for braving such a sobering dose of hard-core reality. You can kiss my yankie goddam ass. - Aliceinwonderland

Aliceinwonderland's picture
Aliceinwonderland 9 years 15 weeks ago

Wasn't that patriotic!

Greenthumb's picture
Greenthumb 9 years 15 weeks ago

@ Kend: I agree with you about trying to achieve Single Payer in the US in a state by state approach - like we are achieving Marriage Equality for couples other than heterosexuals. And that, "The whole ACA seems to have been pushed on everyone with very little public debate." and that "There must have been a better way to insure them." ...Yes a single payer or Medicare for all system would have been so much better.

But I do not agree with you that "It turned the whole US health care system upside down just to insure 7.5 million people." I believe the Republicans did the "turning ...upside down."

When you say, "I think you are all reading the right wrong. They or I just don't like anything run by the Big Federal monster." ...oh yes the Right does ... It loves, loves loves our military and the "industrial complex" associated with it.

And about trains vs pipelines - I think the jury is out. We have not been using either for long enough, in the VAST quantities of Tar Sands thick sludge, to be able to assess your claim. My solution would be to phase both delivery methods out ASAP and do HUGE local, state and federal programs to phase in alternative energy supplies because we should stop using dirty, polluting fossil fuels and we definitely should leave some of them for following generations who may need them from time to time in an emergency.

And to everyone, please let yourself think about how we can reduce the numbers of humans on the planet. HUMANS are the reason we think we need so much ...(fill in just about anything here). All solutions to try and solve our human "problems," eventually return to the unchecked human "infestation" of the planet .

Kend's picture
Kend 9 years 15 weeks ago

Wow Alice did you get some bad weed or something. Ouch.

Yes Alice unfortunately people do lose everything in Canada because of medical bills. Our system doesn't cover everything. Most Canadians have some kind of private insurance to cover meds, eye care, ambulance etc.. Most employers provide it. As a matter of fact last night there was a lady on the news who has a ill child and is pregant who just was laid off and will lose her home because she is going to lose her health care benifits. I never said you shouldn't change your system I have always said there must be a good mix for both of us. I just mentioned that if you want single payer doing it state by state would be easier.

Kend's picture
Kend 9 years 15 weeks ago

Green thumb, we have been transporting by pipeline that "tar sands oil" for over 65 years. 2.4 million barrels a day from Canada to the US. The fact that you don't seem to know that tells me how safe it is moving it by pipeline. That is what has kept gas prices low in the Midwest for decades. Common sence tells you that moving it by pipeline is far safer and more enviromemtly sound then what you are doing today by tanker across the ocean into the Gulf of Mexico. If it's so bad why doesn't Obama say no. Why drag this on for over six years.

I know you want alternative energy but honestly do you think this is going to happen in less then 30 years and do you have any idea what he cost would be. We have spent trillions and have not change a thing.

PaulHosse's picture
PaulHosse 9 years 15 weeks ago

Obamacare survives. To much has been done to intergrate it into society. To much money has been spent. Yes, it will be tweeked, mostly by individual States, but it remains. And for the record, I still support a single payer program. It would have been easier in inplement, monitor, enforce, and much cheaper. I can only wish that the presnet system is converted to a single payer program, but that just won't ever happen unless, just maybe, it can be done by individual States.

Greenthumb's picture
Greenthumb 9 years 15 weeks ago

Kend I have heard of pipeline spills - one very recently (in Oklahoma? one of those states) where the press was not allowed in to report. Another in Michagan that they're still trying to clean up. Sorry, but I don't have time to do thorough research on comparing pipeline spills vs train crash spills - perhaps another commenter knows more (there's a HUGE list to be sorted through on Wikipedia). But, I don't think either is safe. AND if we could accomplish the changeover in 30 years, I'd also be pleased. I know we cannot accomplish this immediately - sure wish we had seriously started during the Carter administration and that Reagan had not discouraged alternatives and torn down the solar power symbols on the White House. And I'm afraid we will have to invest trillions for the changover (somehow we don't seem intimidated by sums like this when war is concerned). And the cost of not addressing Climate Change will be way more than addressing it. There's no easy, cheap way to solve the mess we've gotten ouselves in.

Aliceinwonderland's picture
Aliceinwonderland 9 years 15 weeks ago

Reply to #12: Excellent points, Greenthumb.

I’d like to clarify why I just came down so hard on Kend. Because whenever this Canadian has anything to say about our problem with healthcare in America, nine times out of ten he’s bleating about the cost and how he thinks a few million more people with health coverage isn’t worth the cost. All this bull crap from someone on the northern side of the border where no one is bankrupted by illness or injury, where no one dies from a preventable, treatable condition. Rubs me the wrong way, knowing that while reading Kend’s stupid, redundant drivel on the subject of healthcare. Occasionally I lose my patience. Hence my last post.

Did you check out either of those links, Kend? No comments eh? Uh-huh… Whatever stakes you've had in that big-ass pipeline will have to be your problem, sir. In a country like this with no viable healthcare system, the last thing WE need is that toxic, filthy sludge passing through our turf.

By the way Kend, I don’t hate you. But I really hate some of your opinions. Have a nice weekend.

RLTOWNSLEY's picture
RLTOWNSLEY 9 years 15 weeks ago

@RichardofJeffer #1 - As Thom stated the wrong judgment from a Conservative majority SCOTUS could lead to the death of several thousand Americans who would be denied healthcare. We have been killing almost fifty thousand low income Americans every year for several years who have been denied any meaningful healthcare due to the high cost of access. Maybe it's going to take such a tragic event to finally wake up a complacent population that will finally demand healthcare for all like all other modern democratic countries on the planet. As for the Supreme Court in general, many founding fathers argued against the implementation of this branch of government as designed because it would be essentially immune from any oversight from the other two branches. At least we should pass a Constitutional Amendment that limits the term of supreme court judges, many of the Bush appointees could potentially remain members of this virtual Star Chamber well into this century.

Kend's picture
Kend 9 years 15 weeks ago

Alice I could not open those links but I will. They are just typing not a link. I promise I will read or watch them.

Aliceinwonderland's picture
Aliceinwonderland 9 years 15 weeks ago

Kend, all ya gotta do is copy those links and paste 'em in that white address bar that appears when you hit the double-tipped expansion arrow at the top right corner of your Safari window and... VOILA!

I do it all the time. Works for me.

ChicagoMatt 9 years 15 weeks ago

Isn't this why healthcare was called the "third rail" of politics? As in, don't touch it...

Even if the ACA survives this court battle, there will be more. It won't ever end. Republican congressmen and women will run against it, and win, for a generation.

Every time a young person is forced to write a check for health insurance, or pay a fine in taxes, even though they don't WANT health insurance, their political views will move to the right.

One of my favorite authors, Dave Barry, once wrote that, "Once you buy a house, be prepared to see your political views pull to the right like a car with a steering problem. You'll begin judging politicians not by their personal lives (so what if he killed someone?), but by their view on taxes (at least he won't raise my property taxes).

It's the same principal with the healthcare mandate.

Take the average early-20-something college student liberal. All bright-eyed and ready to change the world. They want to make a difference. They want to be part of the solution. They want to straighten out everything their parents' generation got wrong.

Now wait about four years, when that student is now in the real world, lucky to be making $30K per year. That's probably divided over two part-time jobs, because employers don't want to hire full-timers, to avoid triggering the ACA employer mandates.

He's thinking of starting a family, maybe buying a house. And here comes this $300/month health insurance bill. He would like to live these early, healthy years without insurance, but it's mandated now. They need his money to pay for the older people in the pool.

Each month, when he sits down to pay his bills, he thinks about what he could do with that insurance premium money. Would he have a house by now? Would he be able to pay down his credit cards? Maybe pay for the wedding his wife really wanted? Who knows?

But one thing's for sure - he will start paying much more attention to policies that affect his bottom line. "Sure, I'm for a woman's right to choose. But I'm even more for my right to choose how I spend my money."

He will also start looking at the people around them - ones that don't work, either by choice or by circumstance. He'll think about all of the other people he knows who spend their time drinking, smoking, and having fun, while he's working extra hard to pay for that mandated health insurance premium.

Then, probably while sitting in traffic on his way to work one morning, it will hit him: Fuck this. Fuck other people. I'm tired of being dragged down by people who can't get their shit together. I'm better off on my own.

He will turn his radio to the local Conservative talk station, and just like that - another Republican is born.

RichardofJeffersonCity's picture
RichardofJeffer... 9 years 15 weeks ago

RLT, I understand what is at risk. The Supreme Court will come done on the side of ACA with dissenting opinion giving Republicans a little political red meat. Roberts and Kennedy will rule for the ACA, regardless of the Republican opposition. They have nothing to fear because Supreme Court justices are nearly untouchable. Injustice Thomas is an shining example of corporate activism on the Supreme Court. Injustice Thomas has ruled twice on Monsanto (company he was employed by) cases since being appointed to the Supreme Court - spoiler alert - Thomas ruled in favor of Monsanto both times.

The Republicans are not going to fight against public subsidies to a private industry. A couple justices will take pot shots at the Obama administration for political theater, but ultimately the court will rule to protect the interest of the insurance industry

Barbaric and inhuman is the best two words to describe our healthcare system even with the public "protection" the ACA provides.

Kend's picture
Kend 9 years 15 weeks ago

Thanks Alice but all I have is my ipad until I get back to work and I can't figure out how I do it on it. Does any one know how to cut and paste on a ipad?

Kend's picture
Kend 9 years 15 weeks ago

Alice I figured it out. Thanks for those. The fact is moving energy is dangerous but it is well worth the risk. There is no getting around it but what are we willing to give up not to use oil and gas. There would be no paved roads, no plastics, no gas stoves or furnaces, many types of medicine, I could go on and on. The fact is to provide us with anything even close to what our lifestyles are we need oil and gas so why not move it as safe as possible. I can't speak for the pipelines down there but the ones up here are very well marked and would be almost impossible to miss. Dail before you dig is free and used always. Keystone with all the attention it has received would be well marked and monitored. If we are honest with ourselves we are 30 to 50 years away from none fossil fuels use at very least. So in the interm why not get it from your best freinds and neighbours, as safe as possible. At very least just say no and let us move on. It's been over six years now.

Mark J. Saulys's picture
Mark J. Saulys 9 years 15 weeks ago

I hate you, Kend.

Mark J. Saulys's picture
Mark J. Saulys 9 years 15 weeks ago

But I have a deep, grudging respect for your great, erudite intellectual mastery and finesse, Kend.


We love your goofy ass, Kend. You came up the hard way and so have lot of worldly knowledge instead of intellectual hot air but I think you might benefit from some reading up and getting informed on issues and things nonetheless.

Take care, buddy.

Mark J. Saulys's picture
Mark J. Saulys 9 years 15 weeks ago

That's right ChristopherCurrie, even 5 years ago it was calculated that the Republican funding cuts to everything from mosquito control programs to food stamps to public hospitals and health clinics would cause more than a 9/11's worth of American deaths every year. Removing Obamacare subsidies in these states, projected to cause 10,000 deaths, would be more than three 9/11s worth.

Mark J. Saulys's picture
Mark J. Saulys 9 years 15 weeks ago

ChicagoMatt, the "Fuck other people attitude" is readily apparent but the "people who can't get their shit together" implies certain presumptions that just aren't founded. Not taking into account one's own privileged background and starting place is convenient for this.

You'd like to be one of the 45 million uninsured? What about your kids?

You know that ACA was a conservative Heritage Foundation, Richard Nixon, Mitt Romney proposal? The whole idea is one of personal responsibility. It being that the uninsured drive up the cost of healthcare for everyone else (an uncontrovertable fact). Hence the mandate, it "mandates" everyone take responsibility for their own healthcare. That kinda flips around who "can't get their shit together" and who's "dragging down" who, doesn't it?

In any case, single payer would've wiped out your objections. Canada's isn't the only or the best system. In England, France, Germany nobody pays a dime and, therefore, certainly doesn't get bankrupted.

You know Matt, I'm still not convinced you're not an entirely fictional character created in the employ of a PR or lobbying firm.

Mark J. Saulys's picture
Mark J. Saulys 9 years 15 weeks ago

Obama said that he will either sign or veto Keystone XL depending on whether it will affect the climate crisis adversley or not. It has since been calculated that the burning of tar sands oil produces 10-15% more CO2 than regular oil and will raise the temperature of the planet .05 degrees or more thus it was vetoed. The issue to Obama wasn't safety in transporting it or of spills, it's whether or not to leave oil in the ground.

chuckle8's picture
chuckle8 9 years 15 weeks ago

KEND -- Don't forget whatever oil can do hemp can do better. The only reason we are not using hemp is because of the lobbying of the carbor corps.

Kend's picture
Kend 9 years 15 weeks ago

Yes Mark, I will I agree. I could learn a lot from reading up. I have the same problem most of us here have. We read too much of what we want to hear and from who we want to hear it from. That is the main reason I am here on Thoms blog. I get to here from the other side. This blog has changed my mind on both our health care systems. We both have a long way to go. Starting with admitting how much it costs. For example on our gas pumps they show where every cent of a dollar goes. Knowing that the government is taking in half of the profit changes everyone's perspective. I don't know if you seen my post when I mentioned mthe meds I bought in Pheonix where $127.00 US and in Canada they where $22.00 CAN. Wouldn't it be nice to see the breakdown on those meds. Someone is making a shitload. Honestly Mark knowing how much more you pay tells me you have serious problems down there and changed my mind on some portions of your system.

ChicagoMatt 9 years 15 weeks ago
You'd like to be one of the 45 million uninsured?

I was, from the ages of 18-26. By choice. I only got insured at 26 because I married in to it. I had jobs that offered insurance. I just didn't want it. I wanted all cash. I would like for my children to at least have the option when they are that age. It's the lack of choice that is the deal breaker.

You know that ACA was a conservative Heritage Foundation, Richard Nixon, Mitt Romney proposal?

Yup. Thom has said that many times. And if states want to do it, then by all means, they should. If a state wants to go single payer, good for them. They should. It would pass easily in some of the bluest states.

Moving things to the federal level is where all of the problems come in. What's the reddest, most anti-Obamacare state in the union? Maybe Wyoming? Why force this on those people, if the vast majority of them don't want it?

You know Matt, I'm still not convinced you're not an entirely fictional character created in the employ of a PR or lobbying firm.

Sometimes I wish I were a fictional character. I'd write a much more exciting life for myself. More fast cars and faster women, less of the Sunday night political blogging.

Mark J. Saulys's picture
Mark J. Saulys 9 years 15 weeks ago

Kend, you got my respect for blogging on this site and you're right, everything is "siloized" these days. The conservatives are only talking to other conservatives and the lefties are only talking to other lefties.

It's because of this new technology and media that everything is "subscriber only" instead of mass, free broadcast media, like before. People only talk to people who already agree with them.

There's no community like there was when everybody was reading the same newspapers and magazines, listening to the same radio stations and watching the same TV networks. I don't think you could have a Watergate scandal now like you did then, for example. We don't come together as a community and discuss things and all matters aren't brought to the light of the community like they were. I think there's actually less transparency than there was before.

mathboy's picture
mathboy 9 years 15 weeks ago

Wikipedia has a list of oil spills, by rail, pipeline and refinery, which, though titled "Complete", is marked just below as incomplete.


chuckle8's picture
chuckle8 9 years 14 weeks ago

Chi Matt -- I would be curious why you think problems arise when you go to the federal level. When complaining about problems at the federal level, remember (paraphrasing W. Churchill) healthcare at the federal level is the worse approach, except for all the others. Since insurance and healthcare are commodities, one is faced with competition between entities without tariffs to balance out the choices.

The articles of confederation, charter mongering and the Eurozone demonstrate that federal oversight of healthcare would be the only workable solution.

ChicagoMatt 9 years 14 weeks ago
Chi Matt -- I would be curious why you think problems arise when you go to the federal level.

An excellent question! Distrust of the Federal government's motives and ability to get things right is ingrained into the minds of many right-wingers now. It's my understanding that it wasn't always this way. That people used to trust the government much more. Things changed in the 60s and 70s. Whatever the reason, we are three or four generations into this distrust now, and it's not going anywhere anytime soon.

So, programs that require some level of willful participation, or at least people not actively working against the program (Obamacare), don't work well at the Federal level. People who want it to fail, because it's Federal, will find ways to make it fail, either by not participating, trying to defund/repeal it, getting public opinion against it, etc...

chuckle8's picture
chuckle8 9 years 14 weeks ago

chimatt -- What you are describing is the specified goal of the Powell doctrine. Lewis Powell, coincidentally, wrote that confidential document to the "billionaires" in 1970.

ChicagoMatt 9 years 14 weeks ago

The Powell doctrine worked. Pointing out that it exists is like pointing out that the Titanic was going too fast when it hit the iceberg. It doesn't raise the ship from the bottom of the ocean.

Progressives need to accept distrust of the Federal government as the norm for a lot of people, and incorporate it into their ideology.

chuckle8's picture
chuckle8 9 years 13 weeks ago

chi matt -- I agree they should accept distrust of repugs in the federal govt. Since Buckley vs Vallejo, they also need a watchful eye on the dems.

The federal government is only a tool. What needs to be watched is who is holding that tool.

As US history has shown us, the only effective defense against the "billionaires" is the federal government. The historical references I see would be the American revolution, Teddy Roosevelt and FDR. Do you have any examples where the states seemed to have had an effective defense against the "billionaires"?

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